Rectocele repair (ODS)

As rectoceles are prevalent in women, rectocele repair is a commonly performed procedure, executed by gynecologists and colon and rectal surgeons. A common difficulty in treating rectoceles is that they are not typically found in isolation, but frequently in association with other structural abnormalities noted on physician examination and imaging, e.g.: enterocele, sigmoidocele, colpocele, rectal intussusception, and solitary rectal ulcer, to name a few. In addition there are associated functional disorders: anismus, pudendal neuropathy, irritable bowel syndrome, rectal hypo sensation, and anxiety/depression. Therefore it is no surprise that the array of treatment modalities ranges from dietary fiber, laxatives, enemas, pelvic floor pelvic training, psychotherapy, to surgery by transanal, trans perineal or transvaginal or abdominal approach. This chapter will address the complications of transanal, trans perineal and transvaginal approaches. The stapled transanal rectal resection (STARR) is also discussed. The most common complications are nonsuccess and recurrences. Complications such as dyspareunia and incontinence are also commonly reported. To optimize outcome, due to the complexity of the presentation of the rectoceles with concomitant structural and functional disorders, careful patient selection extensive workup with multi-disciplinary input, optimization of bowel function, clear outcome expectations and frequently psychological evaluation prior to intervention is necessary.